This is the case of a six-year-old child who presented with a diagnosis of Asperger’s syndrome. He is also hyperactive. He has tantrums and can become aggressive. He has difficulty with social situations. He can be very intelligent  in particular with regard to things that he enjoys such as dinosaurs and maps. He is a picky eater. He has some sensitivity to sounds and dysgraphia.

Incidentally noted was a  misalignment of the eyes. But was this misalignment of the eyes really just an  incidental finding or was it really a great clue as to where this child’s functional lesion originated from. We know that the number one comorbidity associated with autism spectrum disorders is in coordination. We know that the cerebellar and vestibular systems are intimately involved with balance and coordination. We see that many children on the autism spectrum in fact do have functional vestibular lesions as part of their problem and presentation.

So we can evaluate the child’s neurologic system as well as his vestibular system? Here are some things that we might look for . Are his eyes misaligned at rest? Is there any change in the alignment of his eyes with eye movement? Is there any involuntary movement of his eyes? Are his eye movements smooth and not ratchet like? Is his head tilted or rotated? Does the tilt and/or rotation improve when he closes his eyes? Does the child get dizzy easily? If you spin him in various directions, does he have an appropriate vestibular response?

By assessing function and determining where the issue lies, we can begin to formulate a treatment plan that will stimulate that pathway that is under functioning using the concepts of neural plasticity. In this case, we determined that the muscle was functionally short. We determined that there was an issue with the neurologic feedback system and the neurologic control of the length of the muscle. There was an issue with all the neurologic inputs to the muscle that help determine what it’s normal resting length should be. By addressing this functional vestibular lesion as well as other associated neurological dysfunction that we were able to pick up on his examination, the child has made other improvements which are more in line with what  his parents brought him in for. So we know that  the eye misalignment was not his primary complaint or what was a the greatest concern to his parents. However, it is an interesting and observable window into the physiologic changes that can be made with the appropriate functional treatment of his nervous system. That is to say, we cannot see the strengthening connections from his vestibular nucleus to his cerebellum for example but we can see the alignment of his eyes improving. This is what functional neurology is all about, observation, understanding, application and observation again. There was another clue in this child’s history that made it apparent that this was a functional lesion. This child had had three surgeries to correct the misalignment of his eyes. That is,  they would operate to address the length of the eye muscle. The misalignment would correct temporarily and then return. This occurred three times. This is a simple clue to the functional neurology practitioner that indicates that the misalignment was not in fact a structurally short eye muscle but a functionally short eye muscle. That is, that the muscle was shortened due to faulty neurologic integration.

What else are we seeing with this child? His hyperactivity has improved, his temper tantrums have improved and he has not had a bowel or bladder accident in several weeks. His teacher relates that this past week was the first time that the child was able to do his writing work at school. He wrote seven words. The teacher states that he is having improved attention. He also played ball with his father for the first time in his life.

To explain how the  vestibular system may be interrelated with issues such as hyperactivity, tantrums and social deficiencies is beyond the scope of this article. However, you can be aware that vestibular issues are common in children with autism spectrum disorders. Manifestations of vestibular malfunctions such as misalignment of the eyes may be related neurologically to symptoms being expressed as autism spectrum disorder and not an unrelated incidental finding. And now hopefully this is something you are aware of and can observe.

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